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First Name *

Last Name *

Email Address *

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Phone *

Date of birth *

Gender *

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Address Line 1 *

Address Line 2 (opt)

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How did you hear about Walk for autism? *

Connection to autism *

How many years have you participated in Walk for autism? *

I would like to know more about the Workplace Team Challenge so I can get my whole organisation on board.

As a thank you for your pledge to fundraise we will send you a free t-shirt and pedometer.

Or become a Walk for autism 'Green Walker' and choose not to receive a t-shirt and/or pedometer. You'll then go into the draw to win an Xbox!

Order a pedometer

Order a t-shirt

Want extra merchandise? Additional items can be purchased in our store.